Patient Stories: Children's

Children's Memorial Hermann Hospital

Maria Gonzalez and Maria Mendez: A Mother’s Love

It has been said that no influence is as powerful as that of a mother. For Maria Gonzalez, whose daughter Maria Mendez, 14, is the recipient of the first four-organ transplant in Houston and the fourth in the nation, the unconditional love has been reciprocal, providing support for both mother and daughter through years of time-consuming and emotionally exhausting care.

One of Maria Gonzalez’s seven children, Maria Mendez developed short-gut syndrome at the age of six months as a result of a midgut torsion/volvulus that led to the surgical removal of almost her entire small bowel and more than 50 percent of her colon. People who lose a substantial portion of a bowel are required to spend their lives on a regimen of total parenteral nutrition (TPN), which involves intravenous feeding through an implanted vascular catheter.
   

While 60 to 80 percent of patients on TPN tolerate it well, long-term intravenous feeding can lead to serious complications, including catheter infections, catheter blockage, vascular thrombosis and, eventually, liver disease.

In December 2005, Miss Mendez was referred to Ruben Quiros, MD, for evaluation for liver and small-bowel transplantation after developing severe liver disease. A pediatric gastroenterologist affiliated with Children’s Memorial Hermann Hospital and associate professor of clinical pediatrics at The University of Texas Medical School at Houston (UT Medical School), Dr. Quiros managed Miss Mendez’s care, working to keep her well nourished until organs could be located for transplantation. During evaluation for transplantation, he discovered that her kidney function was compromised as well.

“It was nearly a year before we could transplant Maria because of the need for all four organs,” Dr. Quiros said. “Finding a donor was not an easy task. We were dealing with complicated size and match issues. Even though she’s 14, Maria is the size of a nine year old. Her abdominal cavity had not developed normally due to the missing portions of small and large bowel and was virtually nonexistent. As a result, she needed the organs of a three-year-old child.”

During the 10-month wait for available organs, Dr. Quiros saw Miss Mendez almost weekly, managing her nutrition and liver disease, while transplant surgeon Bob Saggi, MD, ensured an infection-free central-line catheter for TPN and assisted in pre-transplant care.

“Maria is an extraordinary case,” said Dr. Saggi, Clinical Assistant Professor at UT Medical School who is affiliated with Memorial Hermann’s Texas Liver Center and the Intestinal Rehabilitation and Transplantation Center. “Most kids don’t make it as long as Maria did on TPN without developing liver disease.”

Miss Mendez owes her life to her mother in many ways, including the intensive attention it took to maintain her on TPN for 14 years. “I’ve always had faith and hope that Maria would get better,” Mrs. Gonzalez said. “In the beginning, it took me a while to understand how serious the problem was. It was a long, slow process of realization.

“My daughter has been a great strength to me. Even with all her problems, she always smiles. Many times when I felt bad, Maria encouraged me by telling me things would be fine. I’ve learned a lot from my daughter’s strength and attitude toward her illness.”

The four organs became available in November 2006. On November 17, transplant surgeons Luis Mieles, MD, Bob Saggi, MD and Hadar Merhav, MD performed the 14-hour operation that gave Miss Mendez a new liver, small bowel and two kidneys.

Because she had virtually no small and large bowel, her abdominal cavity had failed to develop normally. Thus, the complexity of her postoperative care was related to the difficulty of closing her abdominal cavity. However, at the present time she has been off TPN for over one month and being nourished through her new intestinal tract; the first time since she was six months old.

“Without the team effort and infrastructure of the Children’s Memorial Hermann Hospital, we could not have succeeded because the complexity of the surgery is just part of the challenge; the postoperative care must be perfect,” Saggi said.

All four physicians attribute Miss Mendez’s extraordinary survival to the dedication of her mother and the care she provided while raising her six other children. “It’s very time-consuming and emotionally exhausting to raise a child on TPN,” said Dr. Mieles, who is medical director of liver transplantation at the Texas Liver Center and the Intestinal Rehabilitation and Transplantation and a Clinical Professor at UTHSC.

“Most people who have a child with complex health needs find it very overwhelming. It strains marriages, and usually the entire family suffers. Mrs. Gonzalez is extraordinary in many ways. How she was able to cope and maintain Maria’s health through the years with minimal infection is amazing. Normally, children like Maria end up in the hospital six or seven times a year with central-line infections. Mrs. Gonzalez really deserves special recognition and sincere praise.

“This was a very complicated case that required the combined efforts of a multidisciplinary team,” Dr. Mieles noted. “The pediatric ICU at Children’s Memorial Hermann Hospital is one of the best in the nation. The anesthesia during the case was excellent.

“We have a team of people – pharmacists, nurses, nutritionists, social workers and counselors – who worked with us closely to ensure the success of the surgery and recovery. Maria’s new organs are doing well. Without them, she wouldn’t have survived more than six months to a year longer.”

“Maria was a very high-risk patient,” added Dr. Quiros. “This is why we started the program at Children’s Memorial Hermann Hospital. Without it, this little girl wouldn’t have lived.”